Clinical study of C3-C4 level surgical cases of cervical spondylosis

Abstract

Objective: The purpose of this study was to elucidate the pathological characteristics of C3-C4 cervical spondylotic myelopathy (CSM).

Methods: Single-level anterior cervical discectomy and fusion (ACDF) was performed at C3-C4 in 53 patients (38 men, 15 women). The mean duration of preoperative symptoms was 6.0 months. Fifty-three non C3-C4 ACDF patients of our random sample of ACDF patients were compared to the C3-C4 ACDF patients. Clinical outcomes were assessed according to the Japanese Orthopedic Association score (JOA score), the Neurosurgical Cervical Spine Scale (NCSS), and the Nurick scale. And radiological findings including C2-C7 lordosis, C3-C4 range of intervertebral motion (ROM), C2-C7 ROM, and C3-C4%ROM in the cervical spine were evaluated in both groups.

Results: The recovery rates of JOA score and the NCSS in C3-C4 ACDF patients were 62.5% and 62.1%, respectively. The radiological study of C3-C4 ACDF patients showed that they had significant cervical lordosis, and cervical motion was dependent on the C3-C4 segment, which accounted for 39.8% of C2-C7 ROM (total motion).

Conclusion: In C3-C4 ACDF patients, not only static factors, but dynamic factors (instability) at the C3-C4 level contributed to the major causes of CSM.

Keywords: Anterior cervical discectomy and fusion; C3–C4 level; Cervical spondylotic myelopathy; Instability.